Research Review: A meta-analysis of relapse rates in cognitive behavioral therapy for anxiety and related disorders in youth.

BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for youth with anxiety and related disorders, with a 59% remission rate at post-treatment. Results of reviews and meta-analyses indicate that treatment gains are maintained across long-term follow-up, at least in terms of symptom improvement. Less is known about relapse, defined as patients who initially achieve remission status but then experience a return of symptoms after a follow-up period. METHOD: The current study used meta-analysis to determine the overall rate of relapse in CBT for children and adolescents (age 18 years or younger) with anxiety and related disorders. Potential moderating factors of relapse rates, including demographic, methodological, and clinical/intervention characteristics, were also examined. Out of a pool of 78 abstracts, 13 full-text articles were retained for meta-analysis. An additional two articles were identified from other sources (total N = 535 patients). RESULTS: Results showed an overall relapse rate of 10.5% (including comorbid autism spectrum disorder) and 8% (excluding comorbid autism spectrum disorder) across studies. Moderator analyses demonstrated that relapse rates were higher among younger and more racially diverse samples, as well as among patients with comorbid externalizing disorders and those taking psychiatric medications. There were no differences in relapse rates as a function of primary diagnosis. CONCLUSIONS: Taken together, the findings indicate that relapse rates in CBT for anxious youth are relatively low, suggesting that treatment development and refinement efforts should focus on improving treatment response and remission rates for this population.

A meta-analysis of relapse rates in cognitive-behavioral therapy for anxiety disorders.

Cognitive-behavioral therapy (CBT) is a first-line treatment for anxiety and related disorders, with large pre- to post-treatment effect sizes. Rates of relapse, or the likelihood that a state of remission will be maintained once treatment is withdrawn, have been relatively neglected in CBT outcome studies. The present meta-analysis aimed to determine the overall rate of relapse in CBT for anxiety and related disorders. A secondary aim was to assess whether demographic, clinical, and methodological factors were associated with rates of relapse in CBT. Articles were identified from prior CBT meta-analyses and review papers and from literature searches using the PsycINFO and Medline electronic databases, with 17 full-length articles retained for meta-analysis (total N = 337 patients). Results showed an overall relapse rate of 14 %, which did not significantly differ between diagnoses. The way in which relapse was defined was significantly associated with relapse rates; when relapse was defined as meeting diagnostic criteria, estimates were lower than when alternative definitions were used. The findings indicate that relapse following symptom remission occurs in a minority of patients, suggesting that future treatment development and refinement efforts should focus on improving relapse prevention skills and interventions to minimize risk of relapse.

Efficacy and mediators of a group cognitive-behavioral therapy for hoarding disorder: A randomized trial.

OBJECTIVE: Hoarding disorder (HD) is a common and potentially debilitating psychiatric disorder. Thus far, psychological treatments have yielded modest effects and/or were time-consuming and costly to deliver. The aim of the present study was to test the efficacy of a brief group cognitive-behavioral therapy (CBT) for adults with HD and to test hypothesized mediators of treatment outcome. METHOD: Eighty-seven adults with a primary diagnosis of HD were randomized to either immediate CBT or wait list. CBT consisted of 16 weekly, 90-min group sessions that emphasized in-session practice of discarding and refraining from acquiring, decision-making and problem-solving training, emotional distress tolerance, motivational interviewing strategies, and contingency management. Participants were assessed at pretreatment, midtreatment, and posttreatment by an independent evaluator unaware of treatment condition. RESULTS: CBT was efficacious for the symptoms of HD compared with wait list. Saving-related cognitions, but not subjective cognitive impairment, partially mediated treatment outcomes. CONCLUSION: Brief Group CBT is an efficacious and feasible treatment for adults with HD, and is partially mediated by reductions in maladaptive beliefs about possessions. Superiority trials comparing CBT to active treatments, and additional research into mechanisms of treatment outcome, are warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Remission in CBT for adult anxiety disorders: A meta-analysis.

Currently there is no universally accepted definition of remission in anxiety disorders. This may be causing significantly different estimates of treatment efficacy across anxiety disorders. The aim of this paper was to determine not only the overall remission rate in cognitive-behavioral therapy (CBT) for anxiety disorders, but also to examine whether the different definitions of remission lead to significantly different remission rates. From the initial 228 abstracts reviewed by the authors, 100 articles were retained. The overall mean remission rate was 51.0%. Remission rates were highest when remission was defined as good end state functioning or no longer meeting criteria for the primary diagnosis. Studies of posttraumatic stress disorder had the highest remission rates, while those of obsessive-compulsive disorder and social anxiety disorder had the lowest remission rates. Rates of remission differed by certain demographic (e.g., older age) and clinical (e.g., medication use) characteristics. Although CBT is an empirically supported treatment for anxiety disorders, it is clear that there is room for improvement, as many patients do not achieve remission status.